The purpose of this study was to examine Residential Care Aides’ (RCAs) experiences of good quality dementia care provision. Informed by a political economy perspective, I sought to understand how RCAs conceptualize quality dementia care, whether such conceptualizations are reflected in their daily care practice and how the organizational care context impedes or facilitates such care provision. Drawing on a focused ethnographic approach, I utilized in-depth interviews, participant observation and the review of selected documents to contextualize RCAs’ experiences within the organizational care environment. Over a 12-month period, in-depth interviews with 29 staff (21 RCAs, 3 LPNs and 5 managers) and 239 hours of participant observation were conducted in four small-scale dementia units in two nursing homes in British Columbia, Canada. In-depth interviews yielded information-rich data about RCAs’ care experiences and their relationships with residents, while participant observation afforded the opportunity to strategically link RCAs’ actions and interactions with what was said, a feature missing from much of the previous research examining staff perceptions of quality dementia care. A select review of facility documents and provincial licensing regulations provided additional insight regarding the relevance of the larger structural context for RCAs’ care experiences. In general, RCAs conceptualized, and exhibited in their daily physical care provision, quality dementia care as that which focused on tangible care outcomes (i.e., keeping residents clean, comfortable, calm and happy), on their care approach (i.e., delivering care in a compassionate, patient and affectionate manner) and was guided by family ideology (i.e., invoking of family metaphors). Inherent in their care provision was a sense of role tension, as they sought to incorporate social interaction with task completion and their co-workers’ conflicting expectations. Study findings also illustrated how, in the face of continued disempowerment and organizational constraints, RCAs sought to provide quality dementia care by negotiating their peer and supervisory relationships and selectively breaking formal and informal policies/procedures. Salient to RCAs’ experiences of personhood was the limited recognition and appreciation they received from management and the manner in which work-life balance, staffing coverage, human resource management practices and limited information sharing further devalued them and their work. Study findings draw attention to the importance of: acknowledging the role of structural constraints in the pervasiveness of a task-oriented work culture; attending to (and facilitating) staff personhood; facilitating supportive peer and supervisory relationships and; fostering effective management practices as a means of potentially improving care quality. As such, the study sheds important light on what RCAs require within their work environments to help facilitate resident well-being, reinforcing the assertion that residents’ care conditions are inextricably linked to RCAs’ care work conditions. / Graduate / 0351

Professional and personal caregivers of persons with Alzheimer’s disease (AD) receive little or no training with regards to the nature, course and accompanying communication challenges of this illness (Haak, 2003). The main aim of the research study was to investigate the interaction between nursing home staff and persons with AD with in a nursing home context, before and after attending a communication-orientated educational workshop for the nursing home staff. Research was carried out by using multiple single case studies. A pre-experimental design was used as the research method. The four participants’ communication skills (verbal, nonverbal and paralinguistic) were evaluated by using the Pragmatic Protocol (Prutting and Kirchner, 1987). Their listening skills were observed and scored according to the Checklist of listening behaviours (Hartley, 1995). A questionnaire was designed to measure the participants’ knowledge and perceptions of different AD aspects. Various shortcomings were identified in the interaction process which highlights the importance of training staff to become competent in using communication strategies that facilitate more successful interaction with persons with AD. The communication-orientated educational workshop (event of the study) was designed according to the data that was collected and based on the person-centred approach of Kitwood (1997). The participants’ communication and listening skills, knowledge and perceptions were evaluated again in the posttest (after the workshop) to determine whether or not there had been a change in these areas. A general view of all the participants’ results showed that there was a significant change in their communication and listening skills. The interaction process was more appropriate during the posttest in comparison to the results that were obtained in the pretest. The participants’ interaction were based more on the principles of the person-centred approach to dementia care than the pretest. There had been a noticeable increase after the workshop in the participants’ knowledge and change to a more positive perception towards persons with AD and the illness. The conclusion has been reached that attendance and participation in a communication-orientated educational workshop leads to more positive interaction with persons with AD. This study has motivated the need for dementia care that is based on the principles of the person-centred approach. It is suggested that an increase in the person-centred approach leads to improvement in quality of life of persons with AD as well as the decrease of the effect of institutionalization in a nursing home setting. Suggestions for future research include that attention should be given to educational programmes with regards to communication strategies for persons with AD. It has furthermore been suggested to approach managers of nursing homes regarding future inservice training of their nursing home staff. / Dissertation (M(Communication Pathology))--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / unrestricted

Aim: The overall aim of the thesis was to explore and describe registered nurses’ (RNs) and certified nursing assistants’ (CNAs) experiences of detection and assessment of pain in older people with cognitive impairment and dementia. A further aim was to evaluate the Abbey Pain Scale-SWE (APS-SWE) in dementia care practice. Methods: An exploratory and descriptive design was used in Study I. An exploratory and interpreting design was used in Study II and Study III. A prospective, descriptive, observational and instrumental design was used in Study IV. Focus group interviews (I) and individual interviews (II, III) were applied to explore and describe RNs’ and CNAs’ experiences of pain assessment in people living with dementia. Qualitative content analysis (I) and philosophical hermeneutics (II) were used to analyse qualitative data. Observation, instrument, and questionnaire were applied to evaluate reliability and face validity of the APS-SWE for pain assessment. Descriptive statistics and reliability analyses were used to analyse quantitative data (IV). Results: RNs in special housing accommodation settings experiences that pain assessment in people with dementia is challenging primarily due to their changed RN consultant role, which to a great extent is directed into administrative and consultative tasks rather than bedside care. This has led to decreased time in daily nursing care, preventing recognising symptoms of pain. This have also led to that RNs are dependent on information from CNAs who are the front-line staff providing daily care (I). CNAs’ perception of signs of pain in people with dementia emerges from being present in the care situation and alertness on physical and behavioural changes that could be due to pain, and from providing the care in a preventive, protective and supportive way to prevent painful situations occurring (II). RNs and CNAs working in home healthcare team use a variety of strategies to detect and assess pain. A trustful work relationship based on staff continuity and a good relation to the person in need of care facilitates pain assessment situations (III). Systematic observation of older people living in special housing accommodation during rest and mobility using the APS-SWE demonstrates that the scale has adequate internal consistency, reliability, and face validity for pain assessment (IV). Conclusions: This thesis found that the RNs’ and CNAs’ detections and assessments of pain rely on solid cooperation, staff continuity, and good knowledge of the person cared for. It was also revealed that there is a lack of using appropriate and assisting pain tools. The APS-SWE show adequate reliability and face validity and can serve as a useful pain tool to assist in detection and assessment of pain in older people who are limited in verbalising pain recognisable. Further evaluation of how the person-centred perspective is applied in pain assessment situations is needed in order to evaluate positive outcomes in people with dementia. Further psychometric evaluation of the APS-SWE in clinical dementia care practice is needed to strengthen validity and reliability. / <p>Study IV</p><p>Karlsson C, Ernsth Bravell M, Ek K, Johansson L &amp; Bergh I (2014): Reliability and face validity of the Abbey Pain Scale-SWE in Swedish dementia care practice. Submitted June, 2015.</p>

Bakgrund: Forskning visar att personer med psykisk sjukdom löper ökad risk för fysisk ohälsa men erhåller inte likvärdig vårdkvalité som övriga patientgrupper. Syfte: Litteraturöversiktens syfte var att beskriva faktorer av betydelse för vårdpersonalens upplevelse av att vårda patienter med psykisk sjukdom inom somatisk respektive psykiatrisk vård samt att beskriva faktorer av betydelse för upplevelsen av att som patient med psykisk sjukdom vårdas inom somatisk respektive psykiatrisk vård. Metod: Litteratursökning utfördes i databaserna PubMed, ScienceDirect, Cinahl och PsycInfo. Efter urval utifrån inklusions- och exklusionskriterier samt kvalitetsgranskning återstod 22 artiklar som analyserades genom innehållsanalys. Resultat: Enligt litteraturöversiktens resultat var attityder och fördomar, yrkeserfarenhet, kunskap och kompetens samt arbetsmiljö faktorer av betydelse för upplevelsen av att vårda patienter med psykisk sjukdom inom somatisk vård. Inom psykiatrisk vård var attityder och fördomar, erfarenhet samt kön faktorer av betydelse. Enligt litteraturöversiktens resultat var vårdrelation och personcentrering faktorer av betydelse för upplevelsen av att som patient vårdas inom somatisk vård. Inom psykiatrisk vård var vårdrelation samt självbestämmande och delaktighet faktorer av betydelse. Konklusion: Resultatet talar för att det råder brist på personcentrering inom såväl somatisk som psykiatrisk vård och att personcentrerad vård är en förutsättning för att kravet om god hälsa och vård på lika villkor ska kunna uppnås. / Background: Research shows that individuals with mental illness have an increased risk of somatic diseases, yet won’t receive equal care as other patients. Aim: The aim was to describe factors relevant to nursing staff’s experience of caring for patients with psychiatric disorders within somatic and psychiatric care respectively, and to describe factors of importance for the experiences of patients with psychiatric disorders who receive care within somatic and psychiatric care respectively. Method: Literature search was conducted in PubMed, ScienceDirect, Cinahl and PsycInfo. After a selection using inclusion and exclusion criteras as well as a quality review 22 articles remained which were analysed using content analysis Results: According to the result of the literature review attitudes and prejudice, professional experience, knowledge and competence and work environment were factors relevant to the experience of caring for patients with psychiatric disorders within somatic care. Within psychiatric care attitudes and prejudice, experience and gender were relevant factors. According to the result of the literature review care relation and person-centered care were factors relevant to the experiences of patients with psychiatric disorders receiving treatment within somatic care. Within psychiatric care, care relation and self-determination and involvement were relevant factors. Conclusion: The results indicate a lack of person centered care in both somatic and psychiatric care and that person-centered care is a prerequisite for the achievement of good health on equal terms.

In this study the researcher developed a training programme for state prosecutors to address re-victimization of the sexually abused child during forensic procedures. The study commenced with a literature study focusing on the following aspects: <ul> <li>Person-centred approach as scientific foundation for the work with sexually abused children during forensic procedures.</li> <li>Sexual abuse and the long-term effects thereof.</li> <li>Addressing re-victimization of the sexually abused child during forensic procedures.</li> After finalizing the literature study, the researcher did the empirical study, which was a combined qualitative-quantitative study. The researcher started with the qualitative study, where prosecutors dealing with sexual abuse cases were interviewed to determine their training needs. After their training needs were determined a training programme was compiled. This training programme formed part of the quantitative study and was implemented during a training session for prosecutors at the Justice College in Pretoria. The programme was also evaluated making use of a pre- and post-test questionnaire to determine whether there was a knowledge improvement after the presentation of the programme. / Thesis (DPhil (Social Work))--University of Pretoria, 2007. / Social Work and Criminology / unrestricted

Bakgrund: Överrapportering vid skiftbyte är en essentiell del av sjuksköterskans kliniska arbete, trots detta råder inte konsensus om vilken rapporteringsmetod som är bästa praxis. I takt med en större personcentrering av vården står patientens rätt till delaktighet och medbestämmande i större fokus, och bedsiderapportering har vuxit fram som ett alternativ till den traditionella rapporten. Syfte: Att belysa hur sjuksköterskor och vuxna patienter i den somatiska slutenvården beskriver sin upplevelse av bedsiderapportering. Metod: Denna litteraturöversikt genomfördes som en förenklad metasyntes där dataanalysen baserades på kvalitativ innehållsanalytisk teknik. Resultat: Tre huvudteman framkom gällande patienters upplevelse av bedsiderapportering: patientmedverkan, bättre vårdupplevelse samt möjliga hinder. Ytterligare tre huvudteman framkom för sjuksköterskors upplevelser: upplevda fördelar, möjliga hinder och förutsättningar för bedsiderapportering. Både patienter och sjuksköterskor beskrev positiva upplevelser av bedsiderapportering med den främsta fördelen att patienten blev mer delaktig i vården. Patienter beskrev en ökad trygghetskänsla och ett tillgodosett informationsbehov. Sjuksköterskor beskrev hur patientsäkerheten förbättrades och prioriteringar underlättades av bedsiderapportering. Oro kring sekretess och känslig information lyftes av både sjuksköterskor och patienter. Slutsats: Bedsiderapportering kan utgöra ett värdefullt verktyg i en mer personcentrerad vård, men att ytterligare kunskap behövs kring hantering av sekretessen. / Background: Shift reporting is an essential part of the nurse’s clinical work, despite this there is no consensus about what constitutes best practice. As personcentredness is becoming more important, more focus is on the patients’ right to participation and shared decision-making, and bedside reporting has become an alternative to the traditional shift report. Aim: To illustrate how nurses and adult inpatients within the somatic care describe their experience of bedside handover. Method: This literature review was conducted through a simplified meta-synthesis approach based on qualitative content analysis as a tool for the analysis of data. Results: Three main themes regarding patients’ experiences of bedside handover emerged: patient participation, improved care experience and possible barriers. Three additional main themes regarding nurses’ experiences emerged: perceived advantages, possible barriers and enabling factors for bedside handover. Both patients and nurses reported positive experiences of bedside handover, with the foremost advantage being the patients’ involvement in their care. Patients described an increased feeling of safety and that their needs of information were met. Nurses described how patient safety was improved and how prioritization was facilitated. Both nurses and patients had concerns about confidentiality and sensitive information. Conclusion: Bedside handover can be used as a valuable tool in the work towards a more person centred care, but there is a need for further knowledge about how confidentiality can be managed.

Bakgrund: Cirka 40 % av de som lider av en demenssjukdom i Sverige bor på särskilt boende. Omvårdnaden som ges bör enligt Socialstyrelsen vara personcentrerad vilket innebär att personens upplevelse sätts i centrum.   Syfte: Att beskriva undersköterskors erfarenheter av personcentrerad omvårdnad för personer med demenssjukdom på särskilt boende.   Metod: En kvalitativ design med semistrukturerade intervjuer. Intervjuerna analyserades med en kvalitativ innehållsanalys som grund.   Resultat: Studien visar två kategorier och fem subkategorier. Den första kategorin är levnadsberättelsens betydelse för personcentrerad omvårdnad där flera erfarenheter av att arbeta utifrån levnadsberättelsen beskrivs. Den andra kategorin är en känsla av otillräcklighet där undersköterskornas vilja att göra mer men inte kunna beskrivs.   Slutsats: Undersköterskornas erfarenheter visar att en väl ifylld levnadsberättelse ger förutsättningar för att ge en god personcentrerad omvårdnad. Informationen som framkommer i levnadsberättelsen gör det möjligt att skräddarsy omvårdnaden kring personen med demenssjukdom. Det finns även en känsla av otillräcklighet hos undersköterskorna och tidsbrist är en bidragande faktor. / Background: About 40 % of the persons suffering from dementia in Sweden lives in nursing homes. According to the National Board of Health and Welfare, the care ought to be person-centred, which means that the person is the centre of the care.  Aim: To describe the experiences of assistant nurses working with person-centred care for people with dementia living in nursing homes.  Method: A qualitative design with semi-structured interviews. The interviews were analyzed with qualitative content analysis.  Result: The outcome of the study shows two categories and five subcategories. The first category is the significance of life story for person-centred care where several experiences to work based on the life story are described. The second category is a feeling of inadequacy where the nursing assistants describes a desire to do more but not be able to.  Conclusion: The nursing assistants experience that a prerequisite to be able to provide a good person-centred care is a life story with a lot of information. The information about the person enables the nursing assistant to customize the care of the person with dementia. There are also feelings of inadequacy expressed by the nursing assistants.

Inledning:  För röntgensjuksköterskor krävs kompetens att kunna bemöta patienter med olika typer av behov, däribland patienter med demenssjukdom och deras särskilda behov. Denna patientgrupp känner sig ofta otrygga och ängsliga och detta förvärras i sjukhusmiljöer. Därför möter röntgenpersonal särskilda utmaningar när det gäller att ge Personer med demenssjukdom den optimala och trygga vård de behöver. Syfte: Syftet med denna litteraturöversikt var att identifiera vilka faktorer som påverkar det korta mötet i vården med personer med demenssjukdom. Metod: Studien utfördes som en kvalitativ litteraturöversikt. En systematisk sökning i databaserna PubMed och CINAHL resulterade i 9 vetenskapliga artiklar som kvalitetsgranskades och analyserades. Resultatet presenterades som kategorier. Resultat: Sex olika faktorer påverkade det korta mötet med personer med demenssjukdom; kommunikation, personcentrerad vård, kunskap, tid, miljö &amp; organisation och anhöriga. Slutsats: Alla dessa faktorer är av stor betydelse för vården av personer med demenssjukdom. För att kunna möta denna patientgrupp på ett värdigt sätt krävs mer tid. Tiden möjliggör för en bättre kommunikation och en mer personcentrerad vård. Mer forskning behövs om det korta mötet på röntgenavdelningen då det saknas i litteraturen. Det hade varit av stort intresse och viktigt att veta hur röntgensjuksköterskan bäst kan möta denna patientgrupps behov trots den tidsbrist som råder i det korta vårdmötet. / Introduction: For radiographers, expertise is required to be able to meet patients with different types of needs, including patient with dementia and their specific needs. This specific patient group often feel insecure and anxious and this is exacerbated in hospital environments. Therefore, radiographers face special challenges when it comes to providing persons with dementia with the optimal and safe care they need. Aim: The aim of this literature review was to identify which factors that affect the short meeting in the care of people with dementia. Method: The study was conducted as a qualitative literature review. A systematic search in the databases PubMed and CINAHL resulted in 9 articles that were quality checked and analyzed. The results were presented as categories. Results: Six different factors affected the short meeting of persons with dementia; communication, person-centred care, knowledge, time, environment &amp; organization and relatives. Conclusion: All these factors are of great importance for the care of persons with dementia. To be able to meet this patient group with dignity more time is required. Time allows for better communication and more person-centred care. More research is needed on the short meeting in the radiology department as it is lacking in the literature. It would have been of great interest and importance to know how the radiographers best can meet the needs of this patient group despite the lack of time in the short care meeting.

Andelen äldre i befolkningen blir fler och fler och med det behövs ökade insatser från vård och omsorg. Om förändrat vårdbehov upptäcks hos en patient i samband med sjukhusvistelse bör ett planeringsmöte bokas inför utskrivningen från sjukhuset. Under planeringsmötet skapas en vårdplan som ska vara individuell och personcentrerad där patientens resurser ska tillvaratas. Syftet med studien var att belysa den äldre patientens upplevelse av sitt planeringsmöte vid utskrivning från sjukhus. En kvalitativ metod genomfördes med en induktiv ansats. Åtta patienter intervjuades. Intervjuerna analyserades genom en kvalitativ innehållsanalys och resulterade i två huvudkategorier: osäkerhet inför planeringsmötet och underläge under planeringsmötet. Resultatet visade att informationen som ges inför mötet ofta upplevs otydlig men det uppskattas att det är en sjuksköterska som ger informationen. Patienterna upplevde även anhörigas närvaro som en trygghet under mötet. Resultatet visar även på att det under mötet framkommer många okända begrepp och att informationen under mötets gång är överväldigande. Tydlig information, individuella förutsättningar och patientens delaktighet är förbättringsområden för en hållbar utveckling inom området. / The proportion of older people in the population is increasing and with this increased health efforts are needed. If a changed need for care is daiscovered in connection with a hospital stay, a discharge meeting can be booked upon discharging from the hospital care. During the discharge meeting, a care plan is created that should be individual and person-centered where the patient's resources are to be utilized. The aim of the study was to illustrate the older patient's experience of their discharging meeting. Eight patients were interviewed using a qualitative method with inductive approach. The interviews were then analyzed through a qualitative content analysis and resulted in two main categories: uncertainty before the discharge meeting and be at a disadvantage during the discharge meeting. The result showed that the information given before the discharge meeting was often unclear but it was appreciated by the patients that it was a nurse who provided the information. The patients also experienced the presence of relatives created the feeling of being safe for the patient during the discharge meeting. The results also show that many unknown concepts emerged during the meeting and that the information during the meeting is overwhelming. Distinct information, individual prerequisite and the patients participation are clear areas of improvement for sustainable development in the area.

Bakgrund. I omvårdnaden ska distriktssköterskan se till människans hela situation och omvårdnaden ska utföras på ett personcentrerat och säkert sätt. I hemsjukvården utförs vården i patientens hem, antingen i ordinärt eller särskilt boende. Trycksår är en vanlig vårdskada och nutritionen är viktig för att förebygga och behandla trycksår. Syftet var att beskriva i vilken utsträckning som distriktssköterskor i hemsjukvården använder nutritionsåtgärder som trycksårsbehandling. Metod. För att besvara syftet användes en kvantitativ design där redan insamlad data från en trycksårsmätning togs del av. Resultatet visade att nutritionsåtgärder användes som trycksårsbehandling till 65% av patienterna. Bland varannan distriktssköterska som inte använde nutritionsåtgärder framkom olika orsaker. Det var vanligare att nutritionsåtgärder användes vid risk enligt riskbedömningarna MNS och SF-MNA. De vanligast använda nutritionsåtgärderna var näringsdryck och extra mellanmål. Resultatet visade att det fanns skillnader i trycksårens svårighetsgrad i förhållande till boendeform. Slutsats. Det fanns utrymme för förbättringar i att använda nutritionsåtgärder vid trycksår. Nutritionen spelar en betydelsefull roll i behandlingen av trycksår och det är viktigt att riskbedömningar utförs. Genom att tidigt använda nutritionsåtgärder som trycksårsbehandling kan distriktssköterskan främja hälsa, förebygga sjukdom och skada samt minska patientens lidande. / Background. In Nursing Care, it's important to see to the whole perspective of the patient, and the care should be performed in a person-centred and safe way. The purpose was to describe district nurses [DN] using of nutrition therapy as treatment for patients with pressure ulcers in home healthcare. Method. A quantitative design, where material from an already collected pressure ulcer study, was used. The result showed that nutritional therapy was used as pressure ulcer treatment in 65% of the patients. Among every other DN who did not use nutritional therapy as treatment of pressure ulcer, various causes were identified. It was more common to use nutritional therapy when risks according to MNS and SF-MNA assessments were found. The most common nutrition therapies were nutritional drinks and extra snacks. The result showed that there were differences in the severity of pressure ulcers in relation to patients' housing type. Conclusion. There was room for improvements in using nutrition therapy as pressure ulcer treatment. Nutrition plays an important role in the prevention and treatment of pressure ulcer, and it's important that risk assessments are performed. By initiating nutritional treatment early, the DN can promote health, prevent disease and injury, and reduce the patient's suffering.